Provider Demographics
NPI:1295098325
Name:ADESANYA, MARGO REE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARGO
Middle Name:REE
Last Name:ADESANYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:MARGO
Other - Middle Name:REE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:6911 LAUREL - BOWIE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715
Mailing Address - Country:US
Mailing Address - Phone:301-464-1800
Mailing Address - Fax:301-464-5033
Practice Address - Street 1:6911 LAUREL - BOWIE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715
Practice Address - Country:US
Practice Address - Phone:301-464-1800
Practice Address - Fax:301-464-5033
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice